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Cirugía y cirujanos
versão On-line ISSN 2444-054Xversão impressa ISSN 0009-7411
Resumo
GRYTSENKO, Stepan Y. et al. Clinical outcomes and radiological assessment of vascular anatomy in patients who underwent D3 left hemicolectomy. Cir. cir. [online]. 2023, vol.91, n.6, pp.751-756. Epub 30-Jan-2024. ISSN 2444-054X. https://doi.org/10.24875/ciru.22000425.
Background.
Adequate blood supply is one of the key factors for colorectal anastomosis healing. Various variants of vascular anatomy often come as a surprise to surgeons during operations.
Objectives.
The aims of this study were to carry out a comparative analysis of three-dimensional-computed tomography (3D-CT) angiography data with intraoperative data and a detailed analysis of variants of the anatomy of splenic flexure.
Material and methods.
In this study, we included 103 patients (56 males and 47 females; mean age 64.2 ± 11.6) with the left-sided colon and rectal cancer who underwent preoperative 3D-CT angiography at Ternopil University Hospital between 2016 and 2022.
Results.
According to the recently proposed classification, there are four types of blood supply to the splenic flexure of the colon: Our analysis showed that type 1 was found in 83 (80.6%) patients, type 2 in 9 (8.7%), type 3 in 10 (9.7%), and type 4 in 1 (1%). All patients underwent local left radical hemicolectomy with resection of complete mesocolic excision (CME), central vascular ligation (CVL) and resección (R0). Seven cases were operated laparoscopically; and the median quantity of removal lymph nodes was 21.54 ± 7.32. Positive lymph nodes were revealed in 24.3% cases. AL was diagnosed in one patient.
Conclusions.
Careful pre-operative analysis of vascular anatomy on 3D-CT angiography will assess the vascularization of the splenic flexure of the colon, reduce intraoperative time to identify structures, and develop a personalized strategy for surgery which potentially can reduce the risk of anastomotic leakage.
Palavras-chave : Three-dimensional-computed tomography angiography; Left colic artery; D3 lymph node dissection; Colorectal cancer.